Sunday, January 14, 2018

From Research to Practice: Narrative Studies

As a follow-up to my post last week about narrative skills and abilities in research, I am writing this time about the next article in the Topics in Language Disorders Vol. 28, No. 2; Narrative Abilities: Advances in Research and Implications for Clinical Practice, by D. Boudreau.

Dr. Boudreau notes the importance of narrative skills in academic success and the difficulties of students with language disorders with connected discourse, particularly as they enter the higher grades.

Narrative discourse is defined as, “at least two utterances produced in a temporal order about an event or experience (Hughes, et al, 1997). Students with language disorders tend to miss the ability to integrate background knowledge with pragmatics - or social language - to formulate an organized recounting. Boudreau posits that this difficulty in narrative discourse is greater than in conversation.

The author goes on to cite studies showing that

students whose narrative skills are greater than their syntax skills performed better than those who had age appropriate syntactic skills but poorer narrative abilities or tasks for story comprehension and re-telling,

the single best predictor of students’ future need for remediation or special education or retention was their earlier performance on tasks of narrative abilities,

that there is a correlation between students’ narrative skills using wordless picture books and their Math skills in school,

and more evidence for the role of narrative discourse skills.

So, while we know from the research that narrative difficulties in early years - particularly difficulties with vocabulary flexibility, syntax, and story elements - correlated with academic success, what does this mean for our clinical practice?

Unfortunately, there are studies that contradict the findings of correlation, but for those SLPs who are providing services for these students with impaired narrative skills, we need answers as to what to do. The bottom line, says Boudreau, is that discourse abilities are crucial in academic success, and, in order to make students with this profile successful, we need to provide remediation in both comprehension and production of narratives.

One factor that is shown to have influence on students’ skills in narrative discourse is early interactions around books and experiences. The interactions with parents or other adults that provide scaffolding of story telling / experience retelling, that co-construct narratives with children and gradually decrease that support, are critical. By providing opportunities to interact with partners who provide quality exchanges students develop the narrative skills that they need.

Improved literacy and language skills have been correlated with shared reading. However, not all shared reading is equally helpful. Again, the quality of interactions is important particularly interactions that preview the book, predict throughout, providing quality activities before and after the book is read that focus on some aspect of language (retelling, acting out, discussion of elements of the book).

Another factor is the quality of interactions with adults who provide adequate scaffolding and quality exchanges at dinner time. The quality of these interactions is crucial. It sounds obvious to us SLPs, but parents whose exchanges with their children utilized open-ended questions, contained more complex language and better scaffolding provided better impact that parents whose exchanges were brief, unelaborated, less supported and more brief.

One interesting finding (Spinello & Pinto, 1994; Schneider & Dube, 2005) is that students formed more elaborate narratives when they were not shown picture cues. Use of picture cues resulted in less elaborate narratives, and those that were more informal rather than what would be expected in a written narrative.

In addition to the elicitation-dependent measures, text-dependent measures were also found to be important. Students have been found to more reliably remember specific details if the narrative or story presented to them is a more complete episode, than if they hear only fragments of information in less structured contexts. And if the episode tells about the characters’ goals, motivations, and feelings, students are more likely to remember and retell parts of the story.

In discussing clinical implications of the studies reviewed, Boudreau reminds clinicians to understand the impact of the method they choose to elicit narratives and the types of scaffolding supplied to maximize narrative production. Clinicians should vary the types of narrative tasks they provide in intervention, so that students can take advantage of the scaffolding of different styles of narratives. Of particular importance is understanding and use of the causal network that underlies a story.

Also important for clinical practice is parental/caregiver training that strengthens parents’ - especially mothers’ - strategies used to elicit responses. Talking about daily experiences, using open-ended questions, describing things, and listening carefully are listed among the parental activities that strengthen children’s narratives.

Boudreau also cites studies that have shown that explicit, structured teaching of story grammar enhances students’ understanding and use of these elements in their narratives.

They key take-aways from this article that reviewed research about narrative abilities and the impact of various intervention types on narrative abilities?

Teaching specific story mapping or story grammar elements is an effective therapy strategy

Providing scaffolding in the narrative production of very young children shows an impact in later academic years.

I encourage all SLPs working with children to remember to include narrative skills in their evaluation processes, and to use more than 1 type of elicitation technique; and to include specific structures of narrative style and story grammar in their therapy plans.

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Susan Berkowitz, M.S.,C.C.C., M.Ed. has been a speech-language pathologist for 40 years. She has worked in a variety of settings, both as a SP and as an administrator. She speaks at local, national, and international conferences, and has published research in peer-reviews professional journals. She is currently the Director of Print Content at Speech_Science.org.

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